NOTICE OF PRIVACY PRACTICES

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU MAY GET ACCESS TO THIS INFORMATION. PLEASE READ IT CAREFULLY.

ORTHOPEDIC SURGEONS, P.S.C. is dedicated to protecting your medical information. We are required by law to maintain the privacy of protected health
information and to provide you with this Notice of our legal duties and privacy practices with respect to protected health information. ORTHOPEDIC SURGEONS, P.S.C. is required by law to abide by the terms of this Notice.

HOW YOUR MEDICAL INFORMATION WILL BE USED AND DISCLOSED:

We will use your medical information as part of rendering patient care for treatment, payment and healthcare operations. For example, your medical information may be used by the doctor or nurse treating you, by the business office to process your payment for the services rendered and by administrative personnel reviewing the quality of the care you receive.

We may also use and/or disclose your information in accordance with federal and state laws for the following purposes:

Appointment Reminders, Sign-in Sheets, etc.

• We may contact you to provide appointment reminders. We may also use sign-in sheets and call you by name in our waiting room.

Treatment Information

• We may contact you with information about treatment alternatives or other health-related benefits and services that may be of interest to you.

Treatment Coordination

• We may disclose medical information to third parties (such as other healthcare providers) in order to provide, coordinate or manage your healthcare and related services.

Disclosure to Department of Health and Human Services

• We may disclose medical information when required by the United States Department of Health and Human Services as part of an investigation or determination of our compliance with relevant laws.

Family and Friends

• Unless you object, we may disclose your medical information to family members, other relatives or close personal friends when the medical information is directly relevant to that person's involvement with your care. If the patient is a minor or is legally incompetent, we may disclose the medical information to a parent, guardian, custodian or representative to the extent not prohibited by law.

Notification

• Unless you object, we may use or disclose your medical information to notify a family member, a personal representative or another person that is responsible for your care of your location, general condition or death.

Military Activity and National Security

• When the appropriate conditions apply, we may use or disclose medical information of individuals who are Armed Forces personnel (1) for activities deemed necessary by appropriate military command authorities, (2) for the purpose of a determination by the Department of Veterans Affairs of your eligibility for benefits, or (3) to foreign military authorities if you are a member of the foreign military services. We may also disclose your medical information to authorized federal officials for conducting national security and intelligence activities, including for the provision of protective services to the President or others as authorized by Federal law.
  

Inmates

• We may use or disclose your medical information if you are an inmate of a correctional facility and your physician created or received your medical information in the course of providing care to you.

Disaster Relief, Emergencies

• We may disclose your medical information to a public or private entity, such as the American Red Cross, for the purpose of coordinating with that entity to assist in disaster relief efforts. We may also disclose your medical information in an emergency treatment situation.

Health Oversight Activities

• We may use or disclose your medical information for public health activities, including the reporting of disease, injury, vital events and the conduct of public health surveillance, investigation and/or intervention. We may disclose your medical information to a health oversight agency for oversight activities authorized by law, including audits, investigations, inspections, licensure or disciplinary actions, administrative and/or legal proceedings.

Abuse or Neglect

• We may disclose your medical information if we believe that you have been a victim of abuse, neglect or domestic violence in accordance with federal and state law.

Legal Proceedings

• We may disclose your medical information in the course of certain judicial or administrative proceedings.

Law Enforcement

• We may disclose your medical information for law enforcement purposes or other specialized governmental functions.

Coroners, Medical Examiners and Funeral Directors

• We may disclose your medical information to a coroner, medical examiner or a funeral director.

Organ Donation

• If you are an organ donor, we may disclose your medical information to an organ donation procurement organization.

Criminal Activity

• Consistent with applicable federal and state laws, we may disclose your protected health information, if we believe that the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public. We may also disclose protected health information if it is necessary for law enforcement authorities to identify or apprehend an individual.

Workers' Compensation

• We may disclose your medical information as authorized by laws relating to workers' compensation or similar programs.

Business Associates

• We may disclose your health information to a business associate with whom we contract to provide service on our behalf. To protect your health information, we require our business associates to appropriately safeguard the health information of our patients.

Food and Drug Administration

• We may disclose your health information to anyone required by the FDA to report adverse events, product defects, for product recall purposes, for post-marketing surveillance or for other purposes required by the FDA.

AUTHORIZATIONS:

We will not use or disclose your medical information for any other purpose without your written authorization. Once given, you may prospectively revoke your authorization in writing at any time. To request a Revocation of Authorization form, you may contact us at the address set out below.

YOUR RIGHTS REGARDING YOUR MEDICAL INFORMATION:

You have the following rights with respect to your medical information:

• You may specifically ask us to restrict certain uses and disclosures of your medical information. In other words, you may ask us to not disclose parts of your medical information, or to not disclose such information to family or friends, or for the other purposes set out in this Notice. We are not required to agree to your request, but if we do, we will honor it unless the information is needed to provide emergency treatment.
• You have the right to receive communications from us in a confidential manner, and by alternative means or at an alternative location, if reasonable.
• Generally, you may have a copy of and inspect your medical information. This right is subject to certain specific exceptions, and you may be charged a reasonable fee for any copies of your records.
• You may ask us to amend your medical information. We may deny your request for certain specific reasons. If we deny your request, we will provide you with a written explanation for the denial and information regarding further rights you may have at that point.
• You have the right to receive an accounting of the disclosures of your medical information made by ORTHOPEDIC SURGEONS, P.S.C. during the last six years following April 14, 2003 except for disclosures for treatment, payment or healthcare operations, disclosures which you authorized and certain other specific types of disclosures.
• You may request a paper copy of this Notice of Privacy Practices for Protected Health Information.
• You have the right to complain to us and/or to the United States Department of Health and Human Services if you believe that we have violated your privacy rights. If you choose to file a complaint, you will not be retaliated against in any way.
• If you have any questions regarding our Privacy Practices, wish to complain to us, wish to revoke your authorization, or wish to contact us for any other reason, please contact:

ORTHOPEDIC SURGEONS, P.S.C.
1220 SPRING STREET
JEFFERSONVILLE, IN 47130
(812) 282-8494
ATTN: PRIVACY OFFICERS

THIS NOTICE IS EFFECTIVE AS OF APRIL 14, 2003.

REVISION OF NOTICE OF PRIVACY PRACTICES:

We will abide by the terms of this Notice; however, we reserve the right to change the terms of this Notice, making any revision applicable to all the protected health information we maintain. If we revise the terms of this Notice, we will post a revised notice at our office and will make paper copies of the revised Notice of Privacy Practices available upon request.